Latest Treatment of Mental Impotence

Mike Millers Mental Impotence Healer is an eBook that utilizes guided imagery to help you cure your psychological impotence. In guided imagery, you will be guided into imagining a scenario to guide you to overcome psychological and physical issues. It commonly uses descriptive language and instructions that have direct affects on the brain. Since the mind greatly influences the body, this technique helps you have rock-hard erections when you need them most. Simply listen to The Mental Impotence Healer Program for 60 days and completely annihilate your sexual fears and in next to no time you will become a brand new You! Recharged with sexual energy, bursting with self-confidence, rock solid on command, and conditioned to be aware that your times of Psychological Impotence have dissapeared, permanently! The Mental Impotence Healer Program provides you with your confidence back and will boost your self-esteem to amazing new heights. Listen to the beautiful, calm and relaxing Guided Imagery session and it definitely will totally transform your sex life. You will have control over your erections without taking any harmful medication or dangerous pills. Grab a set of headphones and the recordings will go to work while you relax. The carefully mastered binaural beats and subliminal messages will reprogram your subconscious mind into a radically altered state of heightened sexual awareness and desire! Read more here...

Failure of normal erections occurs with advancing age and it is estimated that around 20 of men between 50 and 70 years of age have moderate or severe ED. The cause of this impotence may be psychogenic, but organic causes (such as diabetes, smoking and peripheral vascular disease) are more likely with increasing age. The mainstays of treatment are the phosphodiesterase type 5 (PDE 5) inhibitors, such as sildenafil, vardenafil and tadalafil. These drugs inhibit breakdown of cyclic guanosine monophosphate (cGMP), thereby enhancing the normal erectile response. They are effective in psychogenic and organic ED. Other modalities of treatment are occasionally necessary including intracaver-nosal prostaglandin E1 and intraurethral vasoactive drug therapy, and vacuum constriction devices. An uncommon side effect of drug therapy for ED is a prolonged erection lasting several hours (priapism), which may lead to ischaemic injury to the erectile tissue in the corporeal bodies. If priapism does...

Although reports have noted relatively low rates of impotence after prostate implantation 33 , this endpoint was only evaluated at two years after implantation. There is a paucity of long-term data critically examining this issue. Stock et al. 33 also reported gradually declining erectile function with continued follow-up after brachytherapy in 89 patients. However, the median follow-up in that report was only 15 months. It appears that impotence rates after TPI are probably underestimated in the literature. With longer follow-up observations, Zelefsky et al. 3 reported that whereas the incidence of impotence two years after implantation was 21 , the rate increased to 42 five years after the procedure. Although the development of erectile dysfunction after prostate brachyther-apy is likely to be a multifactorial phenomenon, the influence of the dose of radiation to the penile bulb may be an important variable. Merrick et al. reported a 61 six-year actuarial rate of erectile...

Throughout history aromas have been linked with sexual response. Perfume jars were preserved in the chambers designed for sexual relations in volcanic remnants of ancient Pompeii. Ancient Sumarians used perfumes to entice women. Traditional Chinese rituals highlight the relationship between smell and affection. Hieroglyphics also relate the two. Virtually all cultures use perfume in their marriage rites. In the modern world as well, the connection is pervasive. Use of perfumes and colognes as romantic enticements are a multibillion dollar business (8). The prominence of the historical connection between odors and sex among diverse cultures implies a high level of evolutionary

The discovery of new products for patient use takes place in laboratories at universities, in the government, or in pharmaceutical companies actually, it starts in the minds of scientists with a scientific innovation or idea for creating a new therapeutic molecule that may be a biological or drug. This research is performed through carefully done studies, either with the physiology of humans or other species, disease models, or some core structure of a molecule, through a host of different scientific technologies. Sometimes, a drug discovery is an accidental finding related to an unexpected action of a drug being studied for other uses, such as Viagra for impotence. Each molecule may have an impact on a general physiologic process such as inflammation and thus have the potential to be used in many organ systems and diseases, or it may impact a specific receptor on a cell, such as a tyrosine kinase, and be used only when the receptor system goes awry. Knowledge of the discovery and...

PROBLEMS OF MEN HyjJfocele VaricoceleEnlarged prostate Impotence Oligospermia Impotence means absent or deficient erection of the penis when attempting sexual intercourse. It is mostly psychological, a result of anxiety. The problem is so distressing that victims run helter-skelter for medical help and fall a prey to unscrupulous quacks.

Another way of decreasing pain from the pelvis caused by endometriosis is to interrupt the nerve fibers that carry pain messages from the pelvic organs and covering. These fibers are part of the sympathetic nerve system the tiny nerves come from both sides of the pelvis and form visible nerve fibers on the surface of the sacrum, hence the term presacral. These nerves don't have any other known function, so cutting them only affects pain sensation. For instance, these nerves don't affect labor or pushing during childbirth, nor do they affect sexual response.

In patients who are on a large dose or who experience side effects of the drug, such as impotence, gynaecomastia, hypotension and weakness due to hypokalaemia, surgery is indicated. Since these tumours are normally unilateral and small, laparoscopic adrenalectomy is the treatment of choice. Total adrenalectomy is normally performed rather than simple extirpation of the tumour from the gland.

Interestingly, extramarital sex norms are not related to these attitudes or behaviors. Neither are premarital and extramarital sex norms and behavior predictably related to another cluster of behaviors related to sex. In particular, male concerns about or incidence of impotence, male boasting about sexual exploits, and incidence of homosexuality are all unrelated to the patterning of premarital and extramarital sex. However, these three aspects of human sexuality are related to each other, so that in societies where male impotence is a theme, males boast about their sexual exploits and homosexuality is absent, while, by contrast, where male impotence is not an issue, homosexuality is present and boasting is absent (Broude, 1976).

It is very important to define the primary outcome and the relative merits of VIP with open and laparoscopic prostatectomy. To address some of these issues, a comparison was conducted of 200 cases of VIP with 100 cases of gold-standard retropubic radical prostatectomy in terms of oncological completeness and preservation of erectile function. Undoubtedly, VIP had the clear edge in terms of less blood loss, less postoperative pain, excellent anatomical anastomosis leading to early achievement of continence, visually superb preservation of neurovascular bundle, shorter hospital stay, and cosmesis 27 . In another report on the outcome of 500 cases of robotic radical prostatectomy, it was observed that the incorporation of robotics resulted in better surgical outcomes in comparison with standard and laparoscopic radical prostatectomy 28 . There are no differences between the procedures in oncological completeness, margin positivity rate, and surgical outcome, in terms of providing...

The disorder (cf., resolution law - attempts to find a partial explanation of behavioral modification whereby the changing of one physiological state into another one becomes easier and quicker after it has taken place a number of times and stages of change theory - suggests the following steps be used to gain the self-control required to change an undesirable behavior pre-contemplation of the advantages and consequences of the change, contemplation of benefits, preparation and action, and maintenance of the change). Wolpe indicates that variables such as food, expression of aggression, and sexual feeling might work, also, to reciprocally inhibit avoidance behavior or anxiety feelings. Wolpe's work on the direct re-education of sexual behavior foreshadowed W. Masters and V. Johnson's widely publicized sexual-response studies, and his emphasis on expression of feeling anticipated the procedure of assertiveness training. See also ALL-OR-NONE LAW PRINCIPLE BEHAVIOR THERAPY COGNITIVE...

The extent of the syndrome ranges from complete androgen insensi-tivity and development of normal external (but not internal) female sexual anatomy, to partial insensitivity, with altered or ambiguous male or female genitals, to mild insensitivity, with normal male genitals, enlarged breasts, and possibly impotence. Treatments depend on the extent of the syndrome, and may include hormone therapy, surgery, and psychological counseling. Gene testing and genetic counseling are available for families with affected members.

With the birth of three or four children, mother and fathers become incorporated in the mekrakramtire (those with many children grade). The social reserve and shame that have constrained a man in both the men's house and his wife's house begins to ease during this life stage, and he may become a public orator and intervene most vigorously in discussion in the men's council. He has probably sponsored a name ceremony for his child which enmeshes him in future obligations to provide food and support to others but also gains him recognition as a peacemaker. Wives of this grade have been ceremonial sponsors along with their husbands and also enjoy the respect accorded parents of honored children. With the birth of grandchildren and the gradual recognition of the diminuition of their own sexual potency, men and women become part of the mebenget (social mentors) grade. As they cease to have young children of their own they are less susceptible to restrictions observed by newer parents. Men...

PRIAPISM Priapism is a persistent and usually painful engorgement of the paired dorsal corpora cavernosa, resulting in a dorsal penile erection, while the glans penis and the ventral surface remain flaccid. The resultant erection is not necessarily associated with sexual stimulation or desire, and it is not relieved by ejaculation. The etiology of the painful engorgement of the corpora cavernosa elements in priapism is thought to center on the autonomic control of blood flow out of the emissary venous system of the penis versus the rate of blood flow into the arterioles and sinusoids of the corpora cavernosa. The flow of blood into the arterioles and sinusoids of the corporal elements may be characterized as either high flow or low flow, reflected in 99mTc penile scan flow studies. The mechanism of high-flow priapism was initially described as a consequence of blunt trauma, whereas the priapism associated with sickle cell disease in adults is usually referred to as low-flow, or...

Therefore the author has argued that the choice of drug between p blocker and calcium-channel blocker should be geared to the needs and the pathophysiology of the individual patient.28 For example in a middle-aged man athletically active and anxious to avoid impotence, a calcium-channel blocker would be first choice. Grade B In a person with a compromised myocardium or with a previous MI, a p blocker appropriately titrated would be first choice. Grade A In someone at high risk of MI, antihypertensive therapy started with a p blocker is somewhat safer than starting with a calcium-channel blocker, while, if the major aim is prevention of stroke and hence intellectual integrity, a calcium-channel blocker may be preferable (Figure 26.1).29

Obtaining a thorough history and physical examination should be the first step in evaluating the patient found to have an adrenal incidentaloma. Functional tumors, primary adrenocortical cancers, or metastases to the adrenal gland can often be diagnosed on the basis of a detailed history and physical examination alone. Questions should therefore be directed to rule out these entities. The patients should be asked about excessive weakness, extremes of mood, or recent unexplained weight changes. Females should be asked about a deepening of their voice, recent growth of hair on their face, chest, or arms, or changes in menstruation. Likewise, males should be questioned about breast enlargement or impotence. All of these questions are directed at identifying benign or malignant functioning adrenocortical tumors that can secrete steroid hormones such as cortisone, aldosterone, or sex hormones. In addition, the presence of symptoms associated with a pheochromocytoma, such as hypertension,...

They should merely be taken at face value). For Jung, dreams compensate for undeveloped archetypes, and for Freud dreams compensate for unfulfilled wishes. Other theoretical approaches to the functions of dreams are provided by B. Wolman who notes the wide variety and range of viewpoints A. Adler suggests that dreams serve a problem-solving function offering cryptic solutions to difficulties the dreamer faces Adler's idea is that the dream is always interpreted as a reflection of the dreamer's attitudes toward the future, especially one's drive toward superiority, and that they are prodromic (they foretell the future) where the dream is a kind of rehearsal for action H. S. Sullivan asserts that dreams satisfy in symbolic ways the needs that may not be discharged in wakeful states and, thus, reduce tension W. Dement and C. Fisher suggest that dreams are safety vales reducing the danger of emotional disturbance where deprivation of dreaming may produce psychosis R. Hernandez-Peon...

Each ejaculation releases 2 to 5 mL of semen, the fluid containing the sperm. Semen normally contains between 20 and 100 million sperm per milliliter. The sperm consists of a 5-p.m head containing the nucleus, a midpiece containing mitochondria, and a 55-p.m-long flagellum, or tail, which can propel the sperm at a speed of 1 to 4 mm min. The seminal vesicles and the prostate gland produce much of the liquid that makes up semen, which includes fructose to provide energy for the sperm, and alkalinity to counter the acidity of the vagina. When the male becomes sexually excited, nerves of the autonomic nervous system produce dilation of arterioles in the penis, causing blood to enter that organ faster than it can leave. This causes the erectile tissue to become engorged, causing an erection. The male then inserts the penis into the female's vagina in the act of copulation, injecting the semen by rhythmic contractions called ejaculations.

Women repudiated by their husbands can never marry again. Even male impotence is not grounds for a Pathan woman to divorce her husband. Obviously, relations between cowives are rarely friendly, and men who can afford to do so will put them under separate roofs, or else maneuver to have the disliked wife return to her family home and then not invite her to return. Since it is assumed that children of a repudiated wife are in danger of poisoning at worst, neglect at best, they accompany their mother, but the boys will return to their father's house when they become young men in order to claim their inheritance rights.

Most of the time surgery removes the whole uterus, the cervix, and fundus. Some physicians advocate leaving the cervix to enhance pelvic support and improve sexual response after surgery. This is called a partial (or supracervical) hysterectomy. Sometimes, especially in cases of severe adhesions and a frozen pelvis, the surgeon may leave the cervix for reasons of safety because it may be dangerous to risk injury to the major blood vessels, intestines, bladder, or ureter. Occasionally, your doctor decides to leave an ovary in place (see the previous section for reasons).

The basic components of nitric oxide (NO) signaling involve nitric oxide synthase (NOS) to synthesize NO and the soluble isoform of guanylate cyclase (sGC) to trap NO. Once activated by NO, sGC converts GTP to guanosine 3'5'-cyclic monophosphate (cGMP), leading to cGMP-dependent physiological responses such as vasodilation. Termination of the cGMP signal involves a cyclic nucleotide phosphodiesterase (PDE). There are multiple PDE isoforms, and selective inhibition of specific isoforms has proven to be clinically useful (for example, sidenifil Viagra in the treatment of erectile dysfunction). sGC must also be turned off however, the in vivo mechanism for this remains unknown. Catalytic activity of constitutive NOS isoforms involved in signaling is controlled by Ca2+ and calmodulin via receptor-mediated events that trigger Ca2+ release from intracellular stores or uptake from external sources.

Soon after the introduction of tea into England, extreme positive and negative effects were attributed to it. A London teahouse advertisement stated that Tea removeth lassitude, vanquisheth heavy dreams, easeth the frame, and strengtheneth the memory. It overcometh superfluous sleep, and prevents sleepiness in general, so that without trouble whole nights may be passed in study. Though some doctors extolled its curative powers, others attacked tea for causing palsies, impotence, leanness, sterility, and nervousness (83).

Certain prescription medications can diminish a man's fertility. High doses of anabolic steroids often reduce sperm count. Additionally, these anabolic steroids can also lead to abnormal sperm, erectile dysfunction, and atrophy of the testicles. Impotence can become a factor for men who take a beta-blocking medication. Beta-blockers are sometimes prescribed to control blood pressure and for certain heart conditions. Examples of beta-blockers include atenolol, propranolol, and nadolol.

First defined as EDRF (endothelium-derived relaxing factor), the biological effects of nitric oxide (NO) have now been definitively characterized in a number of tissues. Smooth muscle is often the target of NO action, leading to vasodilation in blood vessels (Figure 1) and penile erection via NO synthesis in the corpus caverno-sum, two well-established functions. Smooth muscle relaxation in the gut is another important function for NO, playing a key role in gastrointestinal tract motility. NO synthesis in the brain is also well established, though the exact role in learning and memory is still under debate. In the CNS, NO acts as a somewhat atypical neurotransmitter in that it is not synthesized and stored and then released with the appropriate signal, but is synthesized on demand. Constitutive nitric oxide synthases (NOSs) are involved in all of these responses and are under the control of Ca2+ and calmodulin. Receptor-mediated events that trigger Ca2+ release or uptake turn on the...

While using e-technologies has distinct advantages for pharmaceutical companies, some disadvantages and unsafe practices are also associated with these applications. For example, Pill Box Pharmacy, a popular Internet pharmacy, allows visitors to order medications such as Viagra, Propecia, and homeopathic drugs on-line. Visitors connected to the Pill Box Pharmacy Web site can seek an on-line prescription by linking to Medical Center Net a doctor employed by that Web site approves or declines a prescription based on the customer's answers to a preset questionnaire (Weber, 1999). This practice provides potent medication prescriptions without physically evaluating patients. Pamela Gemmel, a spokesperson for Pfizer, the manufacturer of Viagra, has stated that the company does not support such on-line prescription of medication (West, 1998).

Interestingly, patterns of marital interaction are not related to certain other features of male-female interaction. Thus there is no predictable connection between husband-wife day-to-day interaction, mode of choosing marriage partners, honeymoon customs, beliefs about the desirability of frequent sexual activity in marriage, frequency of premarital or extramarital sex for males or females, incidence of or concern about impotence, attitudes toward or frequency of homosexuality, male sexual aggression, rape, or frequency of divorce. There is one exception to this overall pattern. Husband-wife eating arrangements are predictably associated with honeymoon customs and divorce, so that where spouses eat together honeymoon customs are absent and divorce is relatively rare, while where spouses eat apart honeymoon customs are present and divorce is more common. However, the overall lack of a connection between

Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple settings. Skin defects on the penile shaft should be liberally grafted so as to prevent fibrotic scar formation with future erectile problems.

The development of female secondary sexual characteristics in men (e.g., gynaecomastia and tes-ticular atrophy) generally only occurs after the development of cirrhosis. In women, the hormonal changes may reduce libido, disrupt menstruation, or even induce premature menopause. Sexual dysfunction is also common in men with reduced libido and impotence. Fertility may also be reduced, with decreased sperm counts and motility.

A Treat decreased lubrication with KY Jelly or Astroglide. a Menopausal symptoms may respond to oral or topical estrogen. a Sildenafil (Viagra) may be helpful. Lack of orgasm during intercourse is considered a normal variation of female sexual response if the woman is able to experience orgasm with a partner using other, noncoital methods. Sildenafil citrate (Viagra) and other vasodilators are currently undergoing clinical trials with women for sexual dysfunction treatment.

Lambert-Eaton Myasthenic Syndrome (LEMS) is predominantly a disease associated with lung cancer, affecting mostly older men. Patients complain of chronic weakness and fatigue along with autonomic symptoms (e.g. dry mouth and impotence), and the examination shows signs of proximal muscle weakness. Repeated examination of the same limb can sometimes elicit improved strength initially. Eye movements are unaffected except for the pupillary reaction in some cases. Reflexes are diminished. The sensory examination can be normal, but because LEMS is associated with cancer, paraneoplastic or chemotherapy induced neuropathy can lead to a superimposed sensory deficit. Routine laboratory testing may be normal. The differential diagnosis includes myopathies and neuromuscular junction disorders listed above.

The major needs in the field are threefold. First, empirical research is needed on both the process and outcome of sex therapy, especially with minority, gay, and nonmarried populations, as well as multiproblem couples. Second, research on a model to integrate medical interventions (especially Viagra and testosterone) into a couple's intimacy, pleasuring, and eroticism style is imperative. Third, how to prevent relapse and generalize sexual gains to the couple's greater relationship should be explored.

Led to his formulation of the neodissociation theory of hypnosis, involving the concepts of divided consciousness and hidden observer whereby multiple control systems of thought and action are hypothesized as operating independently of each other. A hidden observer is a conjectured, concealed consciousness that is inferred to experience events differently from the hypnotized consciousness, although they operate in a parallel fashion. Hilgard's notion of a hidden observer impacts directly on certain central issues in cognitive psychology, such as the problem of serial versus parallel processing of information. The phenomenon of a hidden observer appears to be similar to the concept of ego-state ego-state theory (Watkins, 1994). The typical hypnotizable individual does not seem to be weak-willed, gullible, hysterical, passive, or submissive to the dominant personage of the hypnotist. Rather, he or she (there seem to be no gender sex differences on this issue) is an individual who has...

Even if the person in front of you is a German woman with acute atopic eczema, the results of the trial may not translate to real clinical benefit to her for several reasons. First, because the treatment effects reported in clinical trials, whether this is a mean change in severity score or proportion of people cleared, refers to groups of people. In a group of patients with a summary treatment effect such as a mean change in SCORAD (SCORing Atopic Dermatitis) of 5 points, there will be some individuals with score changes of 10 or 15 points, some with changes of 3 or 4, some with no change, and possibly some whose disease worsened. For example, closer inspection of the trial data on sildenafil (Viagra) for the treatment of erectile dysfunction7 suggested that some men had all the fun It follows that the patient sitting in front of you might benefit a lot or very little from the proposed treatment, and one has little way of knowing, apart from trying the treatment and seeing what...

Those with less severe pulmonary hypertension and is largely untried in children. The subcutaneous analogue of prostacyclin treponistil (UT-15) is too painful for use in children. The phosphodiesterase inhibitor sildenafil is untrialled, its effect appears to be relatively short lived in sick children, and there is a risk of irreversible retinal damage linked to phosphodiesterase VI inhibition. The proven treatment of choice for the very sick child is chronic intravenous epoprostenol (prostacyclin) therapy. The dose is titrated according to clinical response, subjective and objective. Children generally need much higher doses of prostacyclin than adults and can become very tolerant of the drug, requiring constant, aggressive, upward adjustment of their dosage. Despite the obvious logistical problems, infants and young children can be managed satisfactorily. Training of two family carers by experienced nursing staff and a network of local support is essential. The side effects of the...

Neurological dysfunction of the bladder (the neurogenic bladder) is particularly important to recognize. In the early phases, there is failure fully to empty the bladder such that the bladder enlarges, eventually building up back pressure on the ureters and kidneys. Finally, the patient goes into urinary retention which is often painless due the involvement of the sensory pathways. In the male, neurogenic bladder is accompanied by failure of penile erection and ejaculation.

We evaluated 85 patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU) for biochemical disease-free rate, safety, morbidity, and predictors of biochemical outcome. A total of 85 patients underwent HIFU with the use of Sonablate and with at least 12 months of follow-up. The median age was 70 years (range, 54 to 86 years), and the median preoperative prostate-specific antigen (PSA) level was 10.9ng ml (range, 3.39 to 89.6). The median length of follow-up was 20 months (range, 6 to 56). Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. Biochemical failure developed in 27 (23 85) of the patients. The biochemical disease-free survival rates at 3 years for patients with pretreatment PSA less than 10ng ml, 10.01 to 20.0ng ml, 20.01 to 30.0ng ml,and more than 30.0ng ml were 97 ,75 , 33 , and 0 , respectively. Final follow-up sextant biopsies...

Only small changes needed to occur to move from one system to another. The scent deposits in urine or other bodily secretions that marked territorial boundaries began to mark some animals as subordinate guests in a dominant's territory. In addition to paying homage to dominant individuals by inhaling their markings, subordinates also had to hide or avoid penile erections while observing the erection displays of the dominant males (who had exclusive sexual rights to the group's females), and perhaps also tolerate the dominant's mounting behaviors. In many of these groups adolescent males practiced these dominance displays by alternating roles with each other. In more complex animal societies this adolescent behavior continued among adult males who could mark alliances by alternating subordinate and dominant roles. As these alliances became more complex, the same-sex behaviors came to resemble human homosexuality more and more.

Patient status and treatment-related complications were followed up by all available means, including periodic patient visits and self-administrated questionnaires dealing with urinary continence and erectile function. Serum PSA was usually assayed every 1 to 6 months during follow-up. Postoperative prostate biopsy was performed in all patients at 6 months postoperatively. The American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Panel criterion for biochemical failure, i.e., three consecutive increases in posttreat-ment PSA after a nadir has been achieved, was used to define biochemical failure 20 . The time to biochemical failure was defined as midway between the post-

PRIAPISM Priapism is a urologic emergency that presents as a painful, hard, pathologic erection in which both corpora cavernosa are engorged with stagnant blood. Even though the glans penis and the corpus spongiosum are characteristically soft and uninvolved, urinary retention may develop. Impotence has been reported to occur in 35 percent of cases who have sustained erections for prolonged periods of time thus, expedient treatment and early urologic consultation is required. The potential for medical-legal liability mandates meticulous documentation in these cases. A large number of cases of priapism in adults are pharmacologically related, either to intracavernosal injection for impotence or oral agents for hypertension or mental disorders. Most cases of priapism in children are due to hematologic disorders, usually sickle cell disease. Case reports have attempted to relate a variety of other drugs, metabolic conditions, and trauma to priapism, although the pathophysiologic...

By contrast, medical complaints of male sexual dysfunction undoubtedly increase with age. While all functional aspects of male sexuality libido, potency and ejaculation are reduced in older men, the major impact of ageing is the exponential increase of erectile dysfunction with age (Ayta et al 1999). The last decade has seen a major paradigm shift in understanding of male sexual dysfunction. This includes a public relations makeover in nomenclature (impotence becoming erectile dysfunction), a shift in beliefs about causation (from prevailing Freudian psychoanalytic beliefs on psychosomatic causation, to erectile dysfunction being due to organic neurovascular disorders of cavernosal hydraulics) and development of the first effective pharmacotherapy. The development of vasoactive cavernosal pharmacotherapy was inaugurated by the accidental discovery of papaverine effects during vascular surgery and soon surpassed by the equally fortuitous discovery of oral sildenafil during clinical...

The treatment of primary aldosteronism is dependent upon the etiology. Unilateral adrenalectomy is the treatment of choice for aldosterone-producing adenomas, a procedure that relieves symptoms or ameliorates hypertension in up to 80 of patients.6 Idiopathic hyperaldosteronism, on the other hand, is best treated with antihypertensive medication. Patients with idiopathic hyperaldosteronism typically do not improve after bilateral adrenalectomy which puts them at risk of an Addiso-nian crisis for the rest of their lives.2,5 Therefore, spironolactone is the preferred treatment in these patients, though the occurrence of side effects such as gyneco-mastia and impotence may require the use of an alternative medication such as Amiloride. Amiloride is a potassium-sparing diuretic that effectively treats hypertension while restoring potassium balance.

To be transitory and were easily managed by medical treatment such as alpha-blockers or painkillers such as Voltaren suppository. Urethral catheter in all patients was removed 1 to 2 day postoperatively but catheter was re-indwelled in patients who could not urinate spontaneously and were tried to removal of catheter in every 1 to 2 weeks thereafter. The mean median postoperative urinary catheterization time was 11 14 days (range 0-33 days). Final follow-up sextant biopsies showed 91 (77 85) of the patients to be cancer free. Fifteen (18 ) patients developed a urethral stricture, 3 (4 ) patients underwent transurethral resection of the prostate for prolonged urinary retention or ure-thral stricture, 2 (2 ) and 1 (1 ) patients developed epididymitis and a recto-urethral fistula. Twenty-eight (18 25) patients complained postoperative erectile dysfunction. No incontinence was observed in follow-up.

Surgical repair is usually deferred for posterior urethral injuries. Suprapubic cystostomy is favored by most for bladder drainage. Partial posterior urethral lacerations are managed with a urethral catheter placed coaxially over a guide wire under fluoroscopic control or with a suprapubic catheter. In complete posterior urethral lacerations, the management remains controversial. The injury is managed with primary realignment of the lacerated urethra or with suprapubic cystostomy alone. Stricture formation occurs with both techniques. However, the subsequent urethral stricture in patients with primary realignment tends to be less extensive. The advantage of suprapubic cystostomy alone, especially in an unstable patient, is its simplicity. The impotence and incontinence rates are thought to be related to the extent of injury and are the same for both techniques.

Autonomic neuropathy represents the clinical entities of gastroesophageal reflux disease (GERD), gastroparesis, neurogenic bladder, impotence and sexual dysfunction, autonomic diarrhea (nocturnal, often with incontinence), and orthostatic hypotension. Symptoms of GERD include dysphagia, chest pain, and heartburn. Distinction from myocardial ischemia in the emergency department is often impossible, unless GERD has been previously diagnosed. Gastroparesis is the nonprogressive and nonrhythmic contraction of the gastric antrum, often with pylorospasm. Symptoms include epigastric pain, bloating, anorexia, nausea, early satiety, or vomiting.21 Gastroparesis has been shown to respond to erythromycin, cisapride, and metoclopramide, all of which decrease gastric emptying time. Severe cases may not respond to medication. Constipation is probably the most common gastrointestinal symptom in diabetics and is associated with autonomic neuropathy. The diet should include 30 mg of dietary fiber per...

This process entails the absorption of ever-widening social arenas and behaviors into the jurisdiction of biomedical treatment through a constant extension of pathological terminology to cover new conditions and behaviors. Health clinics, health maintenance organizations, and other medical provider organizations now offer classes on managing stress, controlling obesity, overcoming sexual impotence, alcoholism, and drug addiction, and promoting smoking cessation. Even the birth experience, not just in the United States but also in many

Consuming alcohol of more than one or two drinks per day can affect the quality and quantity of sperm, lower testosterone levels, and contribute to impotence. A 1996 research study from Finland showed that moderate alcohol consumption can kill off some sperm-producing cells within the testicles and also may cause abnormal sperm shapes. A normally shaped sperm should resemble a streamlined tadpole with an oval head and long tail. Abnormally shaped sperm vary in appearance and may have two tails, a tapered head, a crooked kinky shape, or an unusually large or small head. Any of these abnormalities make it so that the sperm is unable to penetrate the surface of the egg and therefore unable to successfully fertilize the egg. Men who partake in heavy alcohol consumption that is, more than six drinks per day are more likely to suffer from low sperm count, poor sperm motility, and abnormal sperm shape.

The Institute for the Study of Health and Illness is a nonprofit educational and research foundation focused on, among other things, the professional development of physicians who serve people who have life-threatening illnesses. Directed by Rachel Remen, MD, it offers books, tapes, and category I CME credit at small retreats that focus on topics such as loss, grief, personal limitation, impotence, isolation, and the examination of goals, values, and meanings. (Contact ISHI, PO Box 316, Bolinas, CA 94924.)

Permanent impotence in men has been reported to be almost universal in some series of abdominoperineal excisions of rectum and occurs in up to half of all men after anterior resection of the rectum for rectal cancer. The incidence of permanent bladder denervation after rectal excisional surgery has been reported to be up to 19 in some series. The presumed mechanism for sexual and urinary dysfunction is damage to the pelvic autonomic parasympathetic and or sympathetic nerves during surgery. The risk of sympathetic nerve damage occurs in the abdomen during ligation of the inferior mesenteric artery pedicle, and high in the pelvis during initial posterior rectal dissection adjacent to the large hypogastric nerves. Lower down, risk to the parasympathetic nerves occurs while dissecting laterally near the pelvic plexus, and during deep dissection of the anterior aspect of the rectum away from the seminal vesicles and prostate near the cavernous nerves. The anterior dissection is thought to...

Nitrates (glyceryl trinitrate, isosorbide dinitrate, sodium nitroprusside) are also used to treat autonomic dysreflexia. If the blood pressure remains high an intravenous drip of sodium nitroprusside could be necessary. Before using these drugs (nitrates), the patient should be questioned regarding sildenafil or other PDE-5 inhibitors. If a PDE-5 inhibitor was used in the last 24 h an alternative short-acting, rapid-onset anti-hypertensive drug should be used. Drugs with these characteristics are captopril and prazosin.

Based on its pluripotent functions, arginine has been widely used in supplemental nutrition for surgical patients, patients with burns, and patients with sepsis and cancer in order to modify the inflammatory response, to enhance organ perfusion, and to stimulate wound healing. However, the benefits of argi-nine supplementation in these conditions are not uniformly proven and accepted. Moreover, arginine is never given alone but is always provided in a mixture of amino acids and other nutrients. The use of NO donors that have vasodilatory actions is an established therapeutic modality in coronary artery disease and for erectile dysfunction. Given this fact it remains worthwhile to clarify the need for arginine supplementation as the natural substrate for NO synthesis in other conditions.

Severe human zinc deficiency has been well characterized by the original descriptions in the Middle East and in patients with acrodermatitis enteropathica. The symptoms of mild deficiency are continued and exaggerated. Thus, stunting can be extreme and is accompanied by delayed sexual maturation and impotence. Characteristic skin lesions are found, originating around the mouth and nose but becoming widespread as deficiency develops. Diarrhea is also present. Deficits in taste and smell are accompanied by anorexia and other behavioral changes, including increased irritability and impaired cognitive function. Eye pathologies similar to those seen in vitamin A deficiency are observed.

Already been treated with radiation therapy. In addition, the option of HIFU may be more attractive to the patient who wants to avoid postoperative incontinence and erectile dysfunction for his quality of life. The small number of patients and the relatively short follow-up period in our series limit our ability to draw any definitive conclusions. We believe that the data we present here suggest that HIFU may be a useful treatment option for patients with localized prostate cancer. Our goal to be able to treat patients with localized prostate cancer by HIFU within one hour in an outpatient clinic under local anesthesia.

With any cancer therapy, there is a fine balance between aggressive disease eradication and increased treatment-induced morbidity, with a corresponding negative impact on QOL. This balance applies to any of the treatment modalities available for localized prostate cancer. As the technique of prostate cryoablation is evolving, and as experience with this modality is increasing, the morbidity reported has steadily declined. Sexual dysfunction and bladder and bowel changes have the greatest negative impact on the lives of prostate cancer patients following treatment for their disease. Historically, urorectal fistula formation was a major concern with prostate cryoablation. Advances in technology and technique have virtually eliminated this concern with cryoablation. Among four recent publications 14,24-26 , only one found rectal complications 14 , with a fistula rate of less than 0.1 . Incontinence in these series ranged from 1.3 to 5.4 , and postoperative impotence ranged from 82.4 to...

Other traditions counsel the believers to choose a partner for breeding (al-nutaf) bravery among the people of Khurasan in Iran , sexual potency among the Berber in North Africa , and generosity and envy among the Arabs (al-Amili, 7 29, tradition 6). The Islamic traditions (hadith literature) do reflect explicit knowledge of eugenics in choosing a marriage partner. The source of these eugenic considerations seems to be the Irano-Semitic culture, in which such interests were commonplace. Although these traditions were never used as authoritative precedents for legislation in the Shari'a, they express the popular piety connected with marital relations. For example, the Prophet is quoted saying, Anyone wishing to follow my tradition should know that among my traditions is marriage. Seek children through it Protect your children from the milk of the prostitute and the insane among women, because milk makes inroads in the character of a child (al-Amili, 1969, 7 4, tradition 6). Moreover,...

Since antiquity grapes have played an important role in the European diet. They were eaten fresh, especially in the grape-growing areas, added to dishes dried or in the form of grape juice, or they were made into wine, the drink of choice for anybody who could afford it. The wild grapevine, a climbing plant like the later cultivars, was indigenous to the area between the Black Sea and Afghanistan. The Phoenicians introduced the vine to Greece sometime after 1000 b.c. from there it spread throughout the Mediterranean. The ancient Egyptians grew grapes, as did the Romans, who were especially fond of various grape syrups in their cuisine. Among them were defrutum, or boiled-down unfermented grape juice, passum, a cooking wine that was even sweeter, and mulsum, a mixture of white wine and honey. As the Roman Empire expanded across Europe, so did the cultivation of grapes, and the art of wine making. In the Middle Ages, great quantities of wine were produced, traded, and consumed in...

And its capsule at open operation (radical prostatectomy). This technically demanding procedure can be performed via a standard open lower abdominal approach, a perineal approach or laparoscopically. It requires the urethra and bladder neck to be joined together when the gland has been removed. Side effects are significant and include erectile dysfunction (ED), urinary incontinence, bladder neck stric-turing and damage to the rectum.